(211) Increasing BMI % In Cystic Fibrosis (CF) Clinic Using Novel Algorithm

Background: Research has shown that BMI >50% is strongly correlated with improved FEV1 and by correlation improves lung function. In January 2021, we reviewed our center data from 2020 and found that the percentage of patients aged 2-19 years old with body mass index (BMI) < 50th percentile was 43.9% compared to the median center average of 36.8%, excluding patients who have undergone a transplant or transferred out of our CF Centers during 2021. We developed a novel algorithm and tracking tool to closely monitor and assess these patients for other contributing medical conditions to improve the BMI in this population. Starting 01/2021 we implemented our algorithm and followed patients until 12/21. We expected to see a 25% improvement in our risk based categories by the 4th quarter of 2021.

Methods: A GI subcommittee was formed, including the physicians, advanced practice providers, dietitians and program coordinator. The committee met monthly and created a BMI protocol and tracking tool. We included children between the ages of 2-19 years of age with BMI < 50% who had been in the CF center for the entirety of 2021. By forming a GI subcommittee, creating a new BMI tracking tool using spreadsheets, we expected to closely monitor our patient’s progress towards improving BMI. We adjusted the data tracked in the BMI tracking tool using several PDSA cycles including adding columns for monthly BMI checks, color coding nutrition risk of the patients that were seen by GI providers, and creating links in the spreadsheet to notate interventions made at each encounter. 3 categories were used: red category for BMI < 25%, yellow category for BMI 25-50% and green for BMI >50%

Results: In January 2021, we had 22 patients in the red category and 47 patients in the yellow category. By the end of 2021, we had seen an improvement in all the categories. By the end of the 4th quarter of 2021, the number of patients in the red category had decreased from 22 to 16 (28% improvement). Patients in the yellow category decreased from 47 to 25 (47% improvement). We added 16 patients in the green category by the end of the 4th quarter.

Conclusions: The GI subcommittee will continue to use this tracking tool to assess ongoing changes in BMI and interventions done to improve patient’s nutritional status. And hope to increase the aim goal by another 10% in 2022. Even though the sample size is small and unable to prove significant improvement, these results greatly exceeded our expectations. With this data the subcommittee will assess the impacts of the BMI tracking tool on overall improvements in BMI and ultimately lead to an increased percentage of patients with a BMI >50th percentile.

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